Provider Demographics
NPI:1205990074
Name:COUNSELING & RECOVERY SERVICES OF OKLAHOMA, INC.
Entity type:Organization
Organization Name:COUNSELING & RECOVERY SERVICES OF OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-492-2554
Mailing Address - Street 1:7010 S YALE AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5713
Mailing Address - Country:US
Mailing Address - Phone:918-492-2554
Mailing Address - Fax:918-494-9870
Practice Address - Street 1:7010 S YALE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5713
Practice Address - Country:US
Practice Address - Phone:918-492-2554
Practice Address - Fax:918-494-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100733450AMedicaid